Dear editor, with interest we read the results of the URGENT 1.5 trial in the article by Koper et al., recently published in the Netherlands Heart Journal [1]. The investigators retrospectively analysed 96 patients with chest pain, of whom 33 (34%) were diagnosed with acute coronary syndrome (ACS). The sensitivity and negative predictive value of the modified HEART score, which integrates fingerstick point-of-care (POC) troponin testing, were 97.0% and 97.6%, respectively. The authors point out that further prospective investigation of the applicability of the modified HEART score in a pre-hospital setting is needed.
We agree that further investigation of this topic should be encouraged. However, prospective studies on the applicability of the pre-hospital modified HEART score have already been performed [2, 3]. Although the POC troponin assay used in these studies was not a high-sensitivity assay nor a fingerstick, their results have shown that pre-hospital assessment of the modified HEART score with this assay is safe.
Moreover, the Dutch ARTICA trial (Acute Rule-Out of Non-ST-Segment Elevation Acute Coronary Syndrome in the (Pre)hospital Setting by HEART Score Assessment and a Single Point-of-Care Troponin; ClinicalTrials.gov, NCT05466591) addressed the above-mentioned issue [4]. In this investigator-initiated randomised controlled trial, we randomly allocated 866 patients with a modified HEAR score (i.e. HEART score without troponin component) ≤ 3 to: (a) standard emergency department admittance to rule out ACS or (b) POC troponin measurement and transfer of care to the general practitioner if troponin concentration was low. The primary outcome was healthcare costs at 30 days, and the secondary outcome consisted of major adverse cardiac events (all-cause mortality, ACS and unplanned revascularisation). Enrolment was completed on 4 May 2022, and the results were presented as a late-breaking clinical trial at the ESC Congress 2022 in Barcelona, Spain.
Funding
The ARTICA trial was funded by a grant from ZonMw.
Conflict of interest
C. Camaro, G.W.A. Aarts and N. van Royen declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.